British Journal of Orthodontics

ISSN: 0301-228X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/yjor19

The Bionator

H. L. Eirew

To cite this article: H. L. Eirew (1981) The Bionator, British Journal of Orthodontics, 8:1, 33-36,
DOI: 10.1179/bjo.8.1.33

To link to this article: http://dx.doi.org/10.1179/bjo.8.1.33

Published online: 21 Jun 2016.

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British Journal of Orthodontics/Vol 8/1981/33-36 030 l-228X/81 /0 I 020033$02.00
©1981 British Society for the Study of Orthodontics

The Bionator
H. L. Eirew
Hampden House, 2 Palatine Road, Manchester M20 9JH

Abstract. The article describes the Bionator appliance, its clinical background and construction.

Introduction jectives as follows:

The Bionator has recently enjoyed a renascence 1. In the labial area, the elimination of lip trap and
for use in selected treatment areas (e.g. Woodside, of the abnormal relationship between the lips
1980) but details of its construction and use may and the incisor teeth.
be unfamiliar to many British orthodontists. 2. The elimination of mucosal damage due to
traumatic deep bite.
3. The correction of mandibular retrusion and the
History associated malposition of the tongue.
The Bionator is an activator-derived device and 4. The attainment of a correct occlusal plane
was introduced by Professor Wilhelm Baiters if necessary by the screening of intrusive tongu~
of Bonn (1893-1973) about 30 years ago. Baiters and cheek musculature.
regarded many malocclusions as due to faulty
muscular function, abnormal posture and deviant These aims are achieved by constructing the
enoral spatial relationships. His views had much in appliances in an edge to edge incisal contact
common with the now largely forgotten writings or as close to it as the patient is able to reach
on 'Cervico-facial orthopaedics' of A. A. Nove in both Class II and Class III cases. This relate~
in this country in the early post-wars years. Baiters' to the working bite of the Fraenkel appliance
treatment system was based on the use of the rather than to that of the conventional activator.
Bionator in conjunction with postural exercises, It results in the instant enlargement of the enoral
gymnastics and even dietary control. His followers space, bringing the tongue forward in Class II
were advised to install wall bars and other exercising cases and back in Class III. The acrylic bulk of
apparatus in their practices for patient guidance the appliance is minimized to permit day-long
and supervision of postural training. Although wear and to maximize oral space. Incisor eruption
these ideas were dismissed as fanciful by many at is prevented, but an open bite is produced between
the time of their formulation, they have more the cheek teeth which will thus be free to erupt
recently been echoed by Fraenkel and other and achieve permanent bite opening and lowering
modern authors. Due to this controversial approach of the mandible. The vestibular wire loops prevent
the Baiters' school remains a relatively small intrusion of the cheeks into the interocclusal
cult group but with a not insignificant following space.
predominantly in Germany, France and Belgium.
Baiters was in his later years prevented by serious Appliance Types
illness from propagating his ideas on a wider
stage. His best known present-day disciples are There are three Bionator variants (Fig. 1):
Professor Ascher of Munich (1968) and Dr Hoff- I. The Standard Appliance for the treatment of
meister of Stuttgart (1980). Class II, Division I.
2. The Screening Appliance for the elimination
of abnormal tongue activity in open bite cases.
Objectives 3. The Reverse Appliance for the treatment of
Eirew (1973) summarized Baiters' treatment ob- Class III.

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H. L. Eirew

space and thereby to discourage full-time wear.

The acrylic reaches from the distal of the upper
canine to 2-3 mm behind the first molars. It
covers only 2-3 mm of mucosa above the gingival
margins of the upper and lower cheek teeth.
The maxillary front remains completely open.
The mandibular anteriors are screened from
tongue pressure but not actually touched by the
anterior plate surface.

a Palatal arch This is made rigidly of 1·2 mm wire

(Fig. 2a). It originates near the maxillary canine/
first pre-molar embrasure. It then rises almost
vertically to the vault of the palate. Roughly on a
line joining the centres of the first pre-molars
(or first deciduous molars) it turns distally to
form the palatal loop reaching a line joining the
distal aspects of the first permanent molars.
This loop should be roughly egg-shaped, horizontal
and I mm clear of the mucosa. Lead foiling of the
model is recommended to avoid pressure points,
because adjustment of the finished arch is almost
impossible without disturbance of its true line.
b On no account should the palatal arch be activated
during treatment in the nature of a Coffin spring.
Its purpose is to stabilize the appliance and to
allow it to be supported by the dorsum of the
tongue. It has been suggested that the wide sweep
of the distal loop, shaped like the blunt pole of an
egg, encourages the tongue and mandible to adopt
a more anterior posture.

Vestibular arch The labial portion should be

ideally shaped and lie at the level of the lip line.
c It is separated from the maxillary central incisors
Fig. 1. (a) Standard appliance. (b) Screening appliance. by a thickness of paper. Foiling may again be
(c) Reverse (Class Ill) appliance (after Baiters). helpful. At the distal of the lateral incisors, the
arch turns downwards and distally to form· the
i:)uccinator loop, which reaches roughly to the
mesial aspect of the upper first permanent molar.
1. The Standard Type It stands about 3 mm clear of the upper model,
(a) Construction rather like the buccal shield of the Fraenkel
Working bite If edge to edge incisal contact is appliance, and its purpose is to hold off cheek
possible, this should be registered by the working pressure from the buccal segments, thereby en-
bite. With an exceptionally severe overjet, a more couraging arch widening. After completing the
relaxed working position is used, based on correct buccinator loop opposite the middle of the upper
canine relationships. In these cases, the lower first pre-molars or deciduous first molars, the arch
incisors should be capped to prevent their further dips down before turning inward clear of the teeth
eruption and tilting. Later, the appliance should below the canine/first pre-molar embrasure, to be
be re-made to an edge to edge bite, without capping. well anchored in the acrylic. To strengthen the
delicate acrylic block, the embedded ends of the
Acrylic The acrylic block is of minimal extent arch wires should be as long as possible and
and thickness so as not to encroach on tongue suitably crimped.

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The Bionator

Fig. 2. Standard appliance. (a) The palatal arch. (b) The vestibular arch.

Lip shields The original Baiters design did not and more rapid clinical progress are normally
suggest the use of lip bumpers, but in the presence observed. Despite its frailer appearance, a well-
of excessive mentalis activity, lip shields of the made Bionator is sturdy and can be used with
Fraenkel type have proved very useful. confidence on long-distance or heavy-handed
patients.
Active components Accessory springs or screws The standard appliance should be employed
are not normally recommended. in mild or moderate cases of Class II with well-
formed arches, little crowding, reduced lower
Facets There is no interocclusal coverage of the facial height and a balance of maxillary proclina-
permanent molars. They are left free to develop tion and mandibular retrusion.
vertically into the enlarged interocclusal space and In severer cases, more pronounced arch narrow-
buccally into the area of reduced pressure produced ing, deep bite, perverted muscular activity and
by the offset of the buccinator loops. The lingual predominance of mandibular retrusion (i.e. near
half of the occlusal surfaces of the deciduous normal SNA, severely reduced SNB), the Function
molars or pre-molars is covered with acrylic as in Regulator of Fraenkel remains the appliance of
an untrimmed Andresen appliance. These facets choice.
are retained intact to allow better seating of the
appliance in the early phases of treatment. When 2. The Screening Appliance (Fig. lb)
eruption of the permanent molars has taken place
This appliance variant is used in cases of Class II
to the desired degree, the pre-molar facets are
progressively removed. It is, however, permissible with anterior open bite and abnormal tongue
activity. It is identical with the standard appliance,
to flatten the facets occlusally from the outset so as
not to obstruct the buccal movement of the covered apart from two special features:
teeth. (i) The central acrylic block is extended upwards,
so that the upper as well as the lower anterior
(b) Clinical management teeth are screened from the tongue. Neither the
Patients should at first be instructed to wear the teeth nor the anterior palatal mucosa should,
appliance full-time in the home (except for meals). however, be touched by the acrylic, so that
After 6-8 weeks, absolute full-time wear except for unobstructed bite closure may take place.
meals and sport should be encouraged. Apart from (ii)Interocclusal bite blocks are left between all
the trimming of facets, only remedial adjustments the posterior teeth to prevent their further
are necessary. eruption. The working bite is taken to comply
with this constructional requirement.
(c) Indications for use
The Bionator, despite its more advanced features, 3. The Reverse Appliance (Fig. Ic)
is basically an activator. Its clinical indications This variant is employed for the treatment of
are therefore similar, but better patient acceptance Class III. It is not as potent as the Fraenkel FR III,

35
H. L. Eirew

but may be used in early or mild cases of Upper lip shields, constructed as for the FR III,
mesiocclusion. The working bite is taken in the have been used to good effect by the author,
most retruded position possible and allowing but were not part of the original Baiters' prescrip-
bare interincisal clearance for the correction of the tion.
anterior crossbite.
The acrylic is set about 1 mm clear of the lower
anterior teeth, screening them completely from the References
tongue. The acrylic extends upwards to cover Ascher, F. (I 968)
l-2 mm of the palatal surfaces of the upper incisors. Praktische Kieferortlwpaedie,
The palatal arch is constructed as for the standard Vienna and Munich: Urban and Schwarzenberg.
appliance, but reversed so that its open end lies Eirew, H. L. (1973)
distally and its round loop roughly on a line Dynamic functional therapy.
WHO Travel Fellowship Report.
joining the middle of the first pre-molars or decid-
uous first molars. Hoffmeister, H. (1980)
Personal communication.
The vestibular arch is again similar to the standard
Woodside, D. G. (1980)
form, but rests against the lower anteriors with Lecture to the Annual Conference of the BSSO in Cambridge,
minimal active pressure. 1980.

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